Provider Demographics
NPI:1255541256
Name:IOCOVOZZI, DAMIANO DE SANO
Entity type:Individual
Prefix:
First Name:DAMIANO
Middle Name:DE SANO
Last Name:IOCOVOZZI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 POPPY ST
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-5002
Mailing Address - Country:US
Mailing Address - Phone:760-323-3517
Mailing Address - Fax:
Practice Address - Street 1:34131 DATE PALM DR
Practice Address - Street 2:
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-6884
Practice Address - Country:US
Practice Address - Phone:760-770-4600
Practice Address - Fax:760-770-1564
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP10685363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMI0778158OtherDEA
CAP39280Medicare UPIN